We need less rhetoric and more reality on social prescribing
It is unacceptable to keep promoting social prescribing schemes on the basis of current evidence, argues Paul Wilson
Social prescribing is being widely promoted and as a way of making general practice more sustainable. The Kings Fund have claimed that there is emerging evidence that social prescribing can lead to a range of positive health and well-being outcomes, and social prescribing schemes feature in many of the New Care Models and Sustainability and Transformation plans or STPs currently being rolled out across the country.
Social prescribing provides GPs with a non-medical referral option that can operate alongside existing treatments to improve health and well-being. Schemes commonly refer patients to a link worker who then works with the person to co-design a nonclinical social prescription to services, usually provided by the voluntary and community sector. The types of activities offered as part of a social prescribing service can aim to help address the psychological problems and low levels of well-being often manifest in frequent attenders in general practice. By addressing these, it is often hoped that there will be a positive impact on frequency of GP attendance.
So does it work?
Building on previous work that aimed to help CCGs make better use of evidence obtained from research in their commissioning decisions and supported by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care in Greater Manchester, we looked at the evidence for social prescribing programmes.
Overall, we identified 15 evaluations conducted in the UK but no convincing evidence for either effectiveness or value for money. Most of the evaluations were small scale and limited by poor design, conduct and reporting. Missing information made it difficult to assess who received what, for what duration, with what effect and at what cost. Since completing our review, we have unearthed another two evaluations that also share the same limitations.
Despite significant methodological shortcomings and a limited evidence base with a high risk of bias, most evaluations present positive conclusions generating a momentum for social prescribing that really isn’t warranted.
Why is evaluation important?
The reality of the evidence base for social prescribing is it is a mess. As such, we are not yet able to reliably judge which, if any, social prescribing programmes are worth pursuing further and or what the added value may be to existing services. Indeed, it could be argued that as the evidence base is so poor, no evaluation would be better, as at least then we would remain certain of our uncertainties.
In the current financially constrained climate this is unacceptable. New ideas and ways of working are not without cost or consequences. They compete with existing services for finite resources. Determining whether new services can deliver gains in health benefits over and above those from existing services is therefore crucial.
If social prescribing is to realise its potential then the evidence base needs to be improved. We need less rhetoric and more reality.
Paul Wilson is Senior Research Fellow at the Alliance Manchester Business School and National institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLARHC) Greater Manchester.
1. King’s Fund. What is social prescribing? 2 February 2017. https://www.kingsfund.org.uk/topics/primary-and-community-care/social-prescribing
2. Bickerdike L, Booth A, Wilson PM, Farley K, Wright K. Social prescribing: less rhetoric and more reality. A systematic review of the evidence. BMJ Open 2017; 7(4):e013384. http://bmjopen.bmj.com/content/7/4/e013384